Application of continuous two-layer suture of gallbladder incision with a single absorbable suture on laparoscopic gallbladder-preserving cholecystolithotomy / 中国内镜杂志

Objective To evaluate the clinical application of continuous two-layer suture of gallbladder incision with a single absorbable suture on laparoscopic minimally invasive gallbladder-preserving cholecystolithotomy. Methods The clinical data of 74 cases underwent laparoscopic minimally invasive gallbladder-preserving cholecystolithotomy were retrospectively analyzed. Main surgical procedures included the longitudinal incision of gallbladder wall, choledochoscopy and the removal of all stones and the closure of the gallbladder incision. The mucous incision was first closed using a 4-0 absorbable suture with continuous everting suture. Using the same suture, the seromuscular incision was then closed with continuous invering suture. The operation time, suturing time, complications and postoperative hospitalization time were also documented. Results Laparoscopic gallbladder-preserving cholecystolithotomy was successfully performed in all cases using the suturing technique introduced in Methods. The operation time was 33~78 min (average 45.11 ± 14.96 min). Suturing time for gallbladder incision was 9 ~ 22 min (average 14.86 ± 3.88 min). No severe complications occurred, such as bile leakage, peritonitis, residual gallstone, hemorrhage or infection. The postoperative hospitalization time was 2~4 d (average 3.21 ± 0.69 d). A postoperative follow-up of 3 ~ 62 months (average 35.50 ± 18.94 months) indicated gallbladder stone recurrence of 2 cases, with a recurrence rate of 2.7%. Continuous two-layer suture of gallbladder incision with a single absorbable suture is a safe, practical and reliable technique for the closure of the gallbladder incision in laparoscopic gallbladder-preserving cholecystolithotomy.

Semi-mature MyD88-silenced bone marrow dendritic cells prolong the allograft survival in a rat model of intestinal transplantation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Semi-mature dendritic cells (DCs) may induce tolerance rather than immunity. However, little is known about the regulatory mechanism by which these DCs induce transplant tolerance. Myeloid differentiation factor 88 (MyD88) is a key adaptor of Toll-like receptor signaling, which plays a critical role in DC maturation. Activation of MyD88-silenced immature DCs results in the generation of semi-mature DCs. We explored the possibility of using these DCs to induce intestinal transplant tolerance in rats.</p><p><b>METHODS</b>MyD88 expression was silenced in bone marrow DCs (F344 rats) using small interfering RNAs for 24 hours, at which point, lipopolysaccharide (LPS) was added to the culture for another 48 hours. These cells were analyzed for their in vitro and in vivo tolerizing capacities.</p><p><b>RESULTS</b>Semi-mature DCs expressing moderate levels of MHC class II and low levels of co-stimulatory molecules were found to produce interleukin (IL)-10, while IL-12 production was decreased. In vitro co-culture with completely allogeneic T cells from Wistar rats led to a significant decrease in alloreactive T-cell responses. In vivo, the transfer of semi-mature DCs (1 × 10(6) cells) followed by the transplantation of fully mismatched intestinal grafts (F344 rats) led to significantly prolonged survival compared to rats receiving immature and mature DCs. Serum from semi-mature DC-treated rats contained lower concentrations of the pro-inflammatory cytokines IL-2 and interferon-γ 5 days after transplantation.</p><p><b>CONCLUSION</b>Semi-mature DCs may promote inducible allograft tolerance and this study suggests a new strategy by which to facilitate the induction of transplant tolerance.</p>

Effect of surgical manipulation on the dissemination of cancer cells into peripheral blood in patients with gastric cancer and its risk factor analysis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of surgical manipulation on the dissemination of cancer cells into blood circulation in patients with gastric cancer and to analyze its risk factors.</p><p><b>METHODS</b>This study included 45 consecutive patients with gastric cancer undergoing curative resection and 13 control cases (10 healthy persons and 3 patients with peptic ulcer receiving gastrectomy). Peripheral blood was obtained preoperatively and just after surgical manipulation. The mRNA levels of carcinoembryonic antigen (CEA) from the blood samples were assayed by reverse transcription-polymerase chain reaction(RT-PCR) and compared between the 2 groups.</p><p><b>RESULTS</b>CEA mRNA was negative in all control cases. Of the 45 gastric cancer patients, the preoperative positive rate of CEA mRNA was 8.9%, while the postoperative positive rate was 48.9%, which was significantly higher than that of preoperation (P=0.000). Multivariable Logistic regression analysis showed that operative duration (P=0.014) and tumor depth (P=0.010) were independent risk factors for cancer cell dissemination. Furthermore, the operative duration in patients with positive postoperative CEA mRNA was markedly longer than that in patients with negative postoperative CEA mRNA (P=0.000), and positive rate of postoperative CEA mRNA in advanced gastric cancer was higher compared with that in early gastric cancer (P=0.034).</p><p><b>CONCLUSIONS</b>Surgical manipulation of curative gastrectomy can provoke dissemination of cancer cells into blood circulation, and the operative duration and tumor invasion depth may be 2 of the risk factors for cancer cell dissemination.</p>